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There are several recognized tribes and communities of Indigenous and First Nations people all over the world. In North, Central, and South America alone, there are estimated to be over 70+ million Indigenous people ("Indigenous Peoples of the Americas").
The below information will be broadly applicable to Indigenous and First Nations people in North America, with some specific notes related to individual communities. For more information on Indigenous peoples' health care needs, please check out our Indigenous/First Nations Health Care guide.
Dietary Restrictions
- No one dietary restriction, do not make assumptions.
- 16% of Native American adults have diabetes, compared with just 8% of white adults. This is largely due to a combination of 1) living in areas where fresh produce and healthier food is difficult or impossible to access, 2) experiencing poverty (24% of Native American households), along with intergenerational trauma and having been removed from land where maintaining a leaner diet and regular physical activity was the norm.
- Frybread, which developed in the late 19th century out of Native American's need to use U.S. government rations of flour and lard, has become a cultural food which brings comfort, and is a staple at events and celebrations.
Health Care Exceptions / Requirements
- Be respectful of any personal spiritual items they have with them: medicine bags, jewelry, feathers, etc. Always ask the patient before handling or moving these items.
- May wish to burn sage to bring purification; spray sage may be more acceptable in hospital or treatment room.
- May be unwilling to sign written consents based on political and personal history of documents being misused.
Family and Visitation
- Autonomy highly valued; do not assume the patient's spouse would make important decisions for them. Patient may need to consider their responsibility to community, family and tribe in the decision-making process.
- Allow time for consultation with family before consenting to any treatment or procedures, if possible.
- Elders are respected and honored.
- Extended family may visit or hold rituals for critically ill person.
Pain Management, Palliative Care
- The patient's "sick role" is traditionally taken to be quiet and stoic.
- Home and folk remedies may be requested and/or preferred.
- In cases of amputation, patient may ask for amputated limb so it can be buried.
- Be prepared to provide support if family wants to bring in tribal healers to attend to the patient's spiritual health.
- American Indian / Alaskan Native peoples have their own long tradition of medicine and healing. For some, holistic individualized medicine that is culturally and linguistically appropriate may be the best intervention.
- Herbal treatments can include teas, tinctures, and salves. One remedy for pain uses bark from a willow tree, which contains acetylsalicylic acid, a.k.a. aspirin.
- Sweating in a sweat lodge, teas that induce various side effects such as vomiting, and smudging with smoke are other traditional methods used to promote healing.
- Prayer is an essential part of some Native American healing practices.
Gendered Care
- No specific preferences for same-gender health care providers; check with the patient to see if they have a preference.
- Some rituals and prayers may be forbidden for non-members to hear/witness/participate in, and even certain genders for members and non-members alike. Please be respectful of the patient's and their family's wishes, and give them privacy during their worship or ritual practice.
Maternity and Childbirth
- C-sections are generally acceptable, although acceptance varies amongst tribes.
- Generally okay with all prenatal and postnatal care.
- May wish to keep umbilical cord for ritual.
Rites, Rituals, and Prayers
- Prayer is an essential part of some Native American healing practices.
- Some rituals and prayers may be forbidden for non-members to hear/witness/participate in, and even certain genders for members and non-members alike. Please be respectful of the patient's and their family's wishes, and give them privacy during their worship or ritual practice.
- Be prepared to support or inquire if family wants to bring in tribal healers to attend to spiritual health.
Geriatric Care
- Acknowledge the intergenerational trauma including the loss of sacred lands, forced assimilation, and family ruptures. Emphasize and validate the strength of the survivors.
- Today American Indians and Alaska Natives are living longer than previous generations, with more functional disabilities than the rest of the population.
- Native American elders may prefer to live at home or in home-like settings. However, many native communities are located in extremely rural areas, may lack electricity and running water, and may be accessible only by dirt roads, all of which make home-based care difficult to access.
- In western Navajo Nation (covering parts of Arizona, Utah, and New Mexico), communities are isolated from one another, and some remain completely cut off from modern amenities such as electricity and water service.
- In Alaska, tribes have begun focusing on home- and community-based services as an alternative to nursing homes, which some villages have struggled to fill and staff. In particular, tribes are exploring small group homes for semi-independent elders, with a community member on site to help prepare meals but no health services provided, as one potential model.
Hospice, End-Of-Life, and Death
- Please be sensitive when discussing hospice, end-of-life care, or anything related to death with the patient or their families. Some Native American tribes believe that speaking of a future event will lead to its occurrence. Some may have Do Not Resuscitate orders in place, while others may not be prepared.
- While being sensitive, it is equally important to not be afraid to have these conversations. Even in Southwestern tribes where ‘‘death’’ is taboo for public discussion, caring for someone during this transition is not taboo and palliative care concepts easily mesh with traditional beliefs.
- In general, families want a system of care that will honor the dying person’s individual and family wishes. Common values include celebrating life, respect for traditional ways, hope for a peaceful death, and access to comfort-focused care while surrounded by family on or near tribal land.
- Family may wish to visit the body of the deceased. Ask if it is acceptable to prepare body in the room before an individual visits.
Resources:
American Cancer Society (2015). Circle of Life: Cancer Education and Wellness for American Indian and Alaskan Native Communities. https://circleoflife.cancer.org/content/dam/cancer-org/microsites/circle-of-life/documents/module9-american-indian-alaska-native-healing.pdf
Center for Disease Control (2017, January 10). Native Americans with Diabetes. CDC Vital Signs. https://www.cdc.gov/vitalsigns/aian-diabetes/infographic.html
Goetz, G. (2012, March 5). Nutrition a Pressing Concern for American Indians. Food Safety News. https://www.foodsafetynews.com/2012/03/nutrition-a-pressing-concern-for-american-indians/
Marr, L., Neale, D., Wolfe, V., & Kitzes, J. (2012). Confronting Myths: The Native American Experience in an Academic Inpatient Palliative Care Consultation Program. Journal of Palliative Medicine, Volume 15 (1), 71-76. https://doi.org/10.1089/jpm.2011.0197.
Ridderbusch, K. (2019, July 22). How The Eastern Cherokee Took Control Of Their Health Care. KHN. https://khn.org/news/how-the-eastern-cherokee-took-control-of-their-health-care/
Roessel, M. H. (n.d.). Working with Indigenous/Native American Patients. American Psychiatric Association. https://www.psychiatry.org/psychiatrists/cultural-competency/education/best-practice-highlights/working-with-native-american-patients
Wintz, Susan K., Handzo, George. (2014). Patients' Spiritual and Cultural Values for Health Care Professionals. HealthCare Chaplaincy Network. (Link)